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One of the most urgent problems of modern urban agglomerations is the optimization of the structure and technological maintenance of transport systems. As one of the options to solve this problem, the development of electric vehicles (EV) is usually suggested. But the scientific community has still not developed a clear understanding of whether electric vehicles are a better alternative to traditional cars, considering all environmental indicators. The aim of this work is to develop a method of forecasting the environmental effects of diffusion of EV technologies and test it on the example of the Krasnodar region of Russia as a region with the highest motorization ratios in the country, a complicated ecologic situation in large cities, a high population density and a modern structure for energy generation.  The technical progress in energy efficiency of each technology is taken into consideration. We use learning theory as a methodological framework, which is common for solution of problems of forecasting technological development. According to the calculations, the total emissions from private motor vehicles, with an increase in energy efficiency of vehicles with internal combustion engine and increase penetration of electric vehicles should decrease in 2025 by 15% comparing business-as-usual scenario, despite a significant increase in the level of motorization (almost 65%). Thus, a wide spread of EV technologies is preferable from an environmental point of view. The proposed approach to predict the environmental effects of diffusion of EV technologies allows us to estimate the reduction in emissions from road transport in any region while maintaining the direction and speed of the following key trends: the growth of energy efficiency and environmental performance of traditional cars with combustion engines, the growth of the level of motorization of the population in Russia, and reduction of EVs costs. Additional effects of stimulating (or de-stimulating) policies are not considered in this model.

A 54-year-old female living in Europe presented with gait ataxia, dizziness, and bilateral hearing loss. Magnetic resonance imaging (MRI) revealed non-specific white matter changes. The patient’s condition gradually deteriorated over two years without diagnosis. The patient continued to decline cognitively and neurologically with worsening ataxia and upper motor neuron signs. Repeat MRI showed worsening white matter changes. Lumbar puncture, not previously done, showed positive Lyme testing. Treatment with intravenous ceftriaxone resulted in marked neurological improvement. Four years after symptom, the patient has short-term memory deficits and chronic fatigue, but is otherwise neurologically, cognitively, and functionally intact. Follow up MRI findings remain largely unchanged. Because cases of intraparenchymal or encephalopathic neuroborreliosis in America are lacking, so are treatment options. We present a rare case and discuss our experience with antibiotic treatment. This case lends evidence to define optimal treatment of this disease, imperative for hastening neurological recovery.

A 23-year-old male with one month of intractable vomiting, subsequent cholecystitis status post cholecystectomy, and overall 40-pound weight loss over the last few months presented with altered mental status and seizures. MRI showed signal abnormalities involving the hypothalamus, periaqueductal gray matter, 4th ventricle, and bilateral thalami, indicative of Wernicke's encephalopathy. The patient was started on empiric IV thiamine and methylprednisolone; thiamine levels were subsequently found to be low. Infectious disease workup was negative. Within a few days of this therapy, the patient's neurological status steadily improved with increased responsiveness and communication. Repeat MRI 7 days after admission showed significant resolution of the signal abnormalities. Over the next several weeks the patient became fully conversational, cognitively intact, and increasingly ambulatory. Nonalcoholic Wernicke's encephalopathy is rare; there have been reports relating it separately to vomiting and invasive surgery. In this case report, we associate it with both recurrent vomiting and minimally invasive cholecystectomy. We also discuss combinatorial therapy of thiamine and corticosteroids, which is poorly defined in the literature. Though there is no consensus-based optimal treatment of Wernicke's encephalopathy, this adds to the discussion of using dual therapy and supports that the use of empiric corticosteroids does not harm the patient.

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